Nine Weeks Post-LPAO

After my RPAO, I started my nine weeks post-op entry jubilant about finally being allowed to wean myself off crutches. Juxtapose that with today's entry, nine weeks after my LPAO and here I've been walking for three weeks already!

Well, that is a bit of an exaggeration. I only ditched the crutches totally about two weeks ago, but since then I've been walking more and more, trying to get my strength up. I went to Europe right after Christmas and although my hip tired easily, for the most part I felt pretty good through airport transfers, post-holiday sale strolls, and museum visits. I even took a 10 mile bicycle ride one ambitious morning.

I can't say my hip was pain-free -- when it got tired, it definitely got sore, but I was good about making sure I always had an "escape route:" a cafe to rest in, a subway to jump on, a cab to hail, etc. so I never got stuck anywhere having to push my hip past its limits just to get home.

Now I'm all moved back into my apartment in NYC, my office at work, my normal life. Well, almost normal. I still don't think I can make it far enough to walk to work yet. And I definitely need some time before I can play tennis again. But I'm progressing really fast and I'll get there soon enough. Who wants to walk to work in these sub-zero temperatures anyway?

Three Weeks Post LPAO

It is now three weeks post-LPAO. At this point last time I had a giant leap in progress. This time, progress on the left hip is just steady and slow. I think the difference (again) is that Dr. Millis didn't have to go into the joint capsule on this left side. The first three weeks of horrendousness after my RPAO probably had a lot to do with the joint capsule having to heal up and stabilize. So while my first three weeks post-LPAO felt better than my first three weeks post-RPAO, I think the recoveries are pulling even now.

PAIN and its MEDICATION

My pain is generally very low. Most of the day I am in little to no pain. I usually wake up with pain around 4 or 5 in the morning, but once I take a Percocet I can make it quite a while until the next one. That ligament (or whatever it is) is still bugging me from time to time, but not nearly as much as it was last week, when it hurt at every step. Now it is just an occasional pinch from time to time.

Sleeping is still not fantastic, but is getting better. I still wake up a few times a night when I have to roll over. I can comfortably sleep on my right (non-op) side for long stretches at a time. The pain gets worse towards the morning when the previous night's bedtime Percocet has worn off. Last night, in a fit of madness, I tried to roll onto my left side. Ouch. I'm not quite ready for that yet.

I am gradually stepping down on the painkillers. This past week I discontinued the Oxycontin altogether and I have been averaging 4 Percocet/day (day being 24-hour period, in this case). I am still taking the Valium as needed.

I haven't stopped Atarax but I think I will this coming week. My hospital rash is long gone and the itchy-red-spots are pretty much gone as well. Just some residual itching here and there.

MOVEMENT

Movement is generally the same as last week. Now that the ligament pain (or whatever it was) has let up, I am less reluctant to crutch around. I have even left the house for dinner at a restaurant and other adventures. I am good on my crutches (after much practice!) and I am strong from my pre-surgery fitness level, so moving around is not a problem when the ligament is not bothering me. Some chairs are still uncomfortable, but I can find ways to sit to minimize the pain.

Because I seem to be healing so fast, I have been entertaining delusions of perhaps getting off crutches earlier this time. But I think that is probably not going to happen. I have been ahead in the healing game with this PAO because of the joint capsule -- but cut bones are still cut bones and they are going to take as long to heal on the left side as they did on the right. So I'm just going to be in this I-feel-fine-I-just-can't-walk limbo phase for longer this time. Great.

INCISIONS

Both my incisions look great: click the links for the pictures. The one that really matters is the right side, since that will be my permanent scar on that side. On the left side they will open the scar back up again to get the screws out in a few months anyway, so who cares what it looks like now.

MOOD

My mood is good; mostly stressed. I have had to work a lot during this recovery and it is leaving me with less time to read and relax than I had during my recovery this spring. It is also draining. In the evening I feel like I am going to collapse from exhaustion once I log off work. Another reason I am not getting as much reading done this time around. Happily there's the holiday weekend coming up so maybe I can get through a book.

Next week is my 1 month post-op in Boston. How the time flies as I limp along behind it.

Two Weeks Post LPAO -- Pain & Itching

Today is two weeks from the date of my LPAO, and I have been home from the hospital for a full week. It has been a bit different than my first week home after my RPAO, which you can read about here and here.

For one thing, my activity level my first week home after this surgery was much higher, and not by choice. After my RPAO, I spent the majority of my first week at home sedentary, reading or sleeping in a couch or bed, moving only when necessary. This past week, I had to work full time the whole week. I was, of course, working remotely from Connecticut, not going into the office. But still, that meant sitting upright in a chair at a desk most of the day, and moving around a lot more than I had done in March. Having to work couldn't be helped, but I do think I could have used a bit more sedentary reclining last week.

My pain has been generally well-managed, except for sometimes sharp pain in two specific places. In March, what pain I had would migrate, popping up in different places every time. This time, the pain is localized in two places: the back of my hip joint (it feels like deep inside where my left buttock meets the top of my thigh, maybe the cut in the ischium?), and above my tailbone, on left side, just above my left buttock.

The former pain has lessened over the course of the week and by now is pretty much resolved. The latter pain is much more common and more severe than the former. That pain above my left buttock is almost constant when I am crutching (each time I take a "step" with my left leg, I feel pain there) and can ache while I am sitting in chairs or lying down, especially if I have just been crutching. I have no idea what it is, it doesn't seem to be located near the surgery site at all. I've got an email in to Dr. Millis asking about it.

My best guess is that there is something going on with the sacrotuberous ligament. That would make sense since one of the hamstring muscles originates from that ligament. Maybe when I step a certain way and activate that muscle, it pulls on the sore ligament? Now why the ligament is sore in the first place is a totally different question. Unless of course it is because that ligament connects the sacrum to the tuberosity of the ischium -- the ischium, of course, being the potential source of my other pain described above and one of the bones cut during a PAO. Gosh, surgeons must love it when patients play doctor using Wikipedia.

Moving on. Unlike on my right side after my RPAO, there is no numb spot on my left thigh after my LPAO. Probably because they didn't have to move the nerves around on the left side.

My incision on the left side is fine. The dressing itches sometimes but not too often. It is not generally tender, although earlier in the week it did feel a bit bruised if I pressed gently on my hip near the top of the incision. We have not changed the dressing on the left side. I imagine it will come off some time this week.

My incision on the right side (where the screws were taken out) does not bother me at all. Obviously it was a much shallower cut than the left side. Its dressing came off on Saturday, but the steri-strips remain.

In the hospital I did have some swelling in the hip area on the left side, and my left foot and lower leg swelled up like the blueberry girl in Willy Wonka for a while. But all that swelling is gone now.

My current pain medication regimen is:

-- 1 Oxycodone every 5 hours during the day
-- 1 Oxycontin twice daily
-- 1 Valium as needed during the day
-- 1 Oxycodone and 1 Valium kept at bedside if needed for pain during the night

It is more pain medication than some other PAO women have taken at this point in their healing, but as I wrote a few days ago, I am not being a sissy; I just seem to need more pain medication than most. I am not worried; I will step it down when I am ready, just as I did in March after my RPAO. But currently, especially with that frequent upper buttock pain, I need pain relief.

As I explained in March, the Oxy painkillers do not make me feel mentally foggy in the slightest. Only the Valium makes me a bit scatterbrained and sleepy, so I never take it when I am working, or trying to concentrate on something important like Gossip Girl.

My horrible skin rash has subsided. Probably primarily because I am not laying in those hospital sheets anymore. Earlier in the week I was applying the prescription steroid rash cream twice daily, but since the rash seems to have been vanquished, I've essentially stopped with them now.

Alas, when one itch dies, another is born. Again I am plagued with the itchy-red-spots problem I had in March, probably a side-effect of the pain medications. I am taking Atarax (thrice daily) to combat the itch, and I also try not to scratch. I carry around Sarna lotion and put that on every time I have an urge to scratch. Needless to say, I am very moisturized. It seems to be working because I feel like I have a few fewer itchy red spots than I did mid-week.

I still take aspirin, but I never wear my TED stockings. No one told me I had to. I wore them on the car ride home from the hospital but that was it.

Recovery Day 4 -- Wireless!

Last night was a terrible night because of the rash. Even though I finally got some steroid creams last night, the itching and discomfort was hardly vanquished, and I had to keep calling for Nubain and Benadryl in between my steroid cream applications.

This morning I wanted nothing more than to leap out of bed, have a shower (preferably stripping away several layers of rash-infested skin in the process) and then marinate myself in steroid cream. Last time I had this operation, I absolutely dreaded getting out of bed because it was so painful and logistically difficult. I think the rash is worse this time around, but I know that getting into and out of bed is somehow much less difficult, so it makes sense that I'm much more amenable to getting out of bed.

Nonetheless, I spent most of my morning in bed, working. So much for taking off from work for two weeks after surgery! Dr. LaReau stopped by to check on me, I ate some fruit salad, time passed.

At 10 my catheter came out. With that, I was wireless! No more leads, IVs, drains, nothing. Just me and my rash.

Finally Kimber came for PT, and it was time to get out of bed again. It went better this time; I was more confident with the limits of what I could do, and I also trusted Kimber more. Once up and in my wheelchair, I was taken to the PT room to try walking on the parallel bars. Again, I was pretty confident about it -- after all, this had been a less invasive surgery and I had already done this learning-to-walk-again thing before.

As all you proverb fans probably guessed, it went terribly. At least I felt it did. Just like in March, I couldn't slide my op-side foot forward to save my life. I was so disappointed and confused. This time they didn't cut that muscle! It is supposed to work! Why can't I move my foot?! Kimber helped me slide my op-side foot forward for each "step" but it just felt like cheating. I couldn't do it myself. The whole endeavor hurt my hip and my pride and I felt like a sad failure. I had thought it would be so much easier than in March and it wasn't.

At least when I got back to my room my sheets were changed. But I didn't get to take that long-awaited shower because (of COURSE) I got the only room on the floor with a bathtub instead of a walk-in shower. Perfect. So I had to wait for a new room to open up so I could switch rooms to take a shower. Which meant getting back into bed to stew in my own boiling skin for a few more hours.

I have been on oral pain medication since the epidural came out yesterday, but I still feel like they are not yet covering my pain properly. There are "gaps" where the pain comes through and when I ask if it is time for some more medicine I end up having an hour or more to wait.

Just like in March, I feel like I always have more pain than I "should" have. I know it is probably in my head, but I just get this vibe from people like they think I can't possibly be in pain when I am taking "so much" medication. But I am not exaggerating my pain. When I ask for medication, it is because the pain is at a distracting level, like 5 to 7. Actually, earlier today, when I told one of my nurses my pain had returned and asked if I could have some more medicine she looked at her watch and sort of sighed disapprovingly and said "you are already on a lot of medication..." It sucks to feel simultaneously like a sissy and a junkie.

At around 15:00 two doctors from dermatology came to look at my rash. They didn't take any photos so I guess they were "the deciders." After some chin-stroking they presented exactly no new ideas and no new solutions. So once again dermatology comes up a day late and a diagnosis short. Give me my steroid creams and go away now please.

In the afternoon I got out of bed again for a second session of PT with Kimber. Needless to say, I was not feeling positive about it, but since I had to get out of bed to get my shower anyway, I figured I might as well hit the parallel bars along the way. For some reason, this time it all went much better. Kimber still had to help me move my left foot forward, but at least it felt like I was contributing this time.

And so I earned my reward. Ahh, a shower and a steroid cream body mask. What a spa treatment. After that I was feeling (and looking) much better, so when Dr. Millis stopped by this evening he was happy to see me looking revived. He said everything is going so well that I might even get discharged tomorrow afternoon. The only things left on my to-do list are final x-rays and showing PT I can climb stairs on crutches. And we all know I can do that. Right?

Recovery Day 2 -- Awakened by Pain and PT

After a calmer-than-usual night of sleep, I was awakened by Dr. LaRue at about 5:30, as he stopped by during his rounds. He took the drain out of my wound. The entire hip/flank area on my left side is hugely swollen and is making me feel enormously fat and distended. I don't recall my corresponding flank being so swollen in March. It almost made me wonder if the drain should stay in a bit longer -- isn't there so much more fluid in there to drain out? But I guess Doctor knows best.

My pain was still at zero this morning, which is even more impressive considering my epidural is set at 8.5 mL/hr this time as opposed to the 12 mL/hr it was at for my right hip in March. So everything is still coming up roses after this second PAO.

With my pain so controlled and my arms so strong, my nurse and I took advantage of the opportunity to give me another sponge bath and change my sheets again. Wow, the hygiene! I will say, though, despite all the prophylactic sheet changing we are doing, my back and flanks are still hot and sticky and pressed into damp sweaty sheets a lot of the time, so I worry that the heat rash may make a reappearance.

Dr. Millis stopped by to remove part of my dressing as well -- the thick ace bandage wrapped around my entire midsection and left thigh. Once he cut that thing off I felt fantastically better. The bandage had been the source of a lot of itching and discomfort so far, and removing it made me far more comfortable. I still had the two bandages over the incisions on either side, but at least the thick itchy girdle covering it all was gone.

After all that activity, I was exhausted, and so I napped from 10 to 12:30, turning away PT's attempts to rouse me into activity in the late morning. I already find PT's in-bed exercises a bit silly, and I am certainly getting tired of the way everyone in the hospital seems to think it is OK to rouse me from my most peaceful slumber for whatever little test (or intern lecture) they have in mind. I thought I read somewhere that adequate sleep (and hydration) were the absolute best medicine?

When I awoke from my healing sleep, I had another headache. (So much for "absolute best medicine, I guess.) I don't usually get headaches, and I don't remember getting any during my hospital stay in March, but this time around I've been having low grade headaches for a lot of the time. Tylenol has only helped about 50% of the time.

I also had another new pain when I woke up from my nap -- my left hip. The hip pain that had been held a zero this entire time had suddenly broken through, and now my left hip ached at about a three or a four -- enough to cause discomfort while lying still, and to cause me to avoid moving the hip if possible.

Nonetheless, I (grudgingly) went through the in-bed exercises with PT when they came back in the afternoon, and I had to postpone my pity party even longer by spending the rest of the day logged on to work (!) taking care of various crises that had popped up in the office since Monday. I was supposed to be able to take time off from work for this surgery, but unfortunately the schedules in my current cases, and the intricacy of my involvement in them, has made my complete absence from work impossible. I can't say that stressing over the projects (and our firm's shoddy remote intranet connection) is helping my healing, but there is not much that can be done about it, so I'm doing what I can, given the circumstances.

Dr. Millis stopped by in the evening to see how I was doing. I told him about today's hip pain and my in-bed PT, he checked my incisions and sensation. He thought all was progressing just fine, but just as a bonus he ordered me to be transfused with a pint of the blood I'd donated autologously pre-surgery.

LPAO Scheduling

It is now a month and a half until my second PAO, this time on my left hip. Even though my left hip has not been in pain for almost two years now (overshadowed, I suppose, by the whinier right hip) I am still going forward with the surgery as planned. In the x-ray taken pre-RPAO, it is clear that my left hip dysplasia is equally as bad as my right hip's was, so I might as well get it over with. Even if the left hip isn't hurting now, it is structurally guaranteed to start hurting eventually.

The schedule I have finalized is as follows:

September 14, 2009 -- Begin rigidly healthy pre-surgery lifestyle: sufficient sleep, healthy and iron-rich diet, no alcohol, regular exercise. The goal is to avoid getting sick, to support my body through the month of blood draws, and be the healthiest and strongest I can possibly be going in to the surgery.

September 25, 2009 -- First autologous blood donation, at the New York Blood Center, with the blood subsequently shipped up to Boston. Begin taking iron supplements; take them up until the surgery.

October 5, 2009 -- Second autologous donation, at the New York Blood Center.

October 20, 2009 -- Pre-operative appointments at Children's Hospital. During this full day in Boston I will meet with Dr. Millis, the anaesthesiology team, physical therapy and admitting. I will also have my third autologous blood donation while I am there.

November 2, 2009 -- Surgery date. Here we go again!

Again I've arranged my absence with work, planning to be completely off the grid for two weeks after the surgery: one week in the hospital in Boston and one week sleeping and healing at my parents' house in Connecticut. During the third week (week of November 16), I plan to begin working remotely from Connecticut, as I did last time.

I plan to stay in Connecticut for about two months after returning from Boston, so I can have the help and supervision I would not have if I returned alone to my apartment in the city. Last time I thought I'd be back in the office in six weeks, but I decided I didn't want to go back until I was off crutches almost entirely, and that wasn't until eight weeks.

Ten Weeks Post-Op -- Walking Again

So now, ten weeks after my surgery, I am back in NYC and walking without crutches, two big steps towards getting back to "normal!"

Last Wednesday I packed up my things and moved from my parents' house in Connecticut back to my apartment in the city. On Thursday and Friday I worked in the office for the first time in over two months.

Thursday I used one crutch for pretty much any walking I did around the office, as well as to and from the office. I took a cab to work in the morning but I took the subway on the way home. On Friday I only used the crutch for getting to and from the office; all day long I walked around in the office without crutches. And on Saturday I went crutch-free all day!

At first I was not very steady walking without the crutch. I don't mean that my balance was off, I mean that my gait was strange and halting. It was as if I'd forgotten how to walk normally. I was overly conscious of my posture and my stride, and I had a sort of limp. I was not in pain -- my hip would get tired and uncomfortable, but it did not hurt in the way it did before the surgery. Mostly it was difficult to get my leg to move properly for the walking stride.

Interestingly, climbing stairs was one of the first things I was able to do "normally". Even a few weeks ago when I still used crutches for everything else, I could climb (not descend) stairs fluidly and without pain or discomfort of any kind. I wonder if this is because stepping up with the operated leg doesn't put the same kind of pressure on the joint as taking a step on flat ground -- and the stair-climbing muscles (hamstring and buttock) were already getting back in shape from my exercise bike riding.

As for the occasional discomfort I've felt these past few days as I have been weaning off crutches, it is the muscles -- not just near my right hip, but throughout both my legs -- that are hurting most as they build back up. Physical therapist Jaime told me to expect this.

Today, for example, my right soleus muscle is quite sore. That makes sense since that muscle is critical for walking and standing, two things which I have not done with that leg in a while. If I am going to be really whiny, my entire right leg is pretty sore, but the soleus is the worst.

I should also mention that as I'm relearning to walk, my right knee is almost as jerky and confused as my right hip. I suppose it is because the right knee fell into just as much disuse as my right hip while I was on crutches and so all it's surrounding muscles need to shape up too. Now when I get up from sitting for a while, my knee is often stiffer than my hip! I can walk it off in a few steps, and it is not painful.

Unsurprisingly, I am exhausted by what used to be standard NYC walking. On Saturday I walked to the Seaport from my apartment (about a half mile each way) and felt like I'd walked a 10K. It gives me a new appreciation for what good walking shape I must have been in before!

My left leg has been quiet through all of this increased activity. I am just waiting for it to start hurting (but hoping it doesn't). Dr. Millis said I can get the left hip done in as soon as a month's time, but I am not anxious to leap back onto the gurney just yet. I'm hoping my left hip can behave itself until October, so I can do all the fun summer activities on my calendar without having to coordinate my outfit with a pair of crutches.

Finally, I should note that the numb spot on the outer thigh of my operated leg is almost entirely gone now. It still feels a little bit strange when I rub it, but much improved from immediately post-surgery. For the most part it is almost back to normal sensation.

Six Weeks Post-Op

Springtime has come to Connecticut, so at least now some of my sitting can be done outside in the sunshine, enjoying the slow colorful explosion of my mother's garden.

A week ago I discontinued painkillers entirely; since then pain has been minimal. A few times I have "overdone it," I suppose, but the pain has been manageable with just a few Tylenol rather than the hard stuff.

I still have not exactly mastered the 1/3 weight bearing, so I am contenting myself with an average of 1/3 weight bearing. Sometimes I step too hard, sometimes I don't step enough; so be it. At this point I don't think I'm going to come crashing down in a heap of shattered bones and bent screws if I happen to step on my leg with full weight.

By now I have been to the gym a few times to ride the exercise bike and do some upper body exercises, which has helped my mood considerably. It feels good to get some blood flowing, even if it is only for thirty minutes at zero resistance. That's right, I am up to thirty minutes on the bike. I asked my physical therapist if I can add resistance or some other leg exercises now, but she said I had to wait until I saw the doctor again before I could be cleared for any increases. So that means I am stuck at this level for three more weeks. ::Sigh::

This week I finally removed the shower chair from my shower. I probably could have removed it last week as I hadn't sat on it in a while.

My incision is still plagued by an open wound at the top. Erin (on Dr. Millis' team) said it is called a "suture abcess" and that I should just keep it covered by a Band-Aid until it goes away. Erin didn't seem worried but I can't say I am very pleased about having an open wound for weeks on end.

Last week's malaise hasn't entirely dissipated, but the lovely spring weather and the gym visits have certainly helped. And as always, I have plenty to do.

Work has been very busy these past couple of weeks, in a stressful way more than in a "happy industry" way. I'm very glad to be working from home; I would not be getting nearly as much done if I were in the city struggling to and from the office and trying to handle life alone in my apartment.

The office has kindly let me extend my "work from home" absence past my originally planned return date of May 1. Now I plan to remain in Connecticut with my infinitely helpful and supportive parents until after my next appointment with Dr. Millis, at which I will hopefully be switched down to one crutch or even a cane.

Three Weeks Post-Op

It is now three weeks post-op and things have definitely improved. Pain is down (as is pain medication), movement is up, and the incision looks amazing. Next week I go up to Boston for my 1-month-post-op visit and then we'll see how much progress I've made internally as well.

PAIN and its MEDICATION

I have far less pain now than I did a week ago, and I get by on far fewer painkillers per day. This past week I have been taking an Oxycontin twice a day, morning and evening, and filling in with Vicodin three times during the day; yesterday I dropped it down to only two Vicodin during the day. This past week I also stopped taking the Valium all together.

Because of the reduction in medication, I don't have the same skin reactions as I did before, so I have stopped taking the Atarax (although I still use the topical rash cream morning and evening in the relevant areas).

My pain is generally very low. Most of the day I am in little to no pain; towards the afternoon I start to feel an ache and that is when I take the Vicodin. If I am going out to something I usually take a Vicodin beforehand as protection, as Dr. Millis suggested, and then I am able to sit through dinners and events with no problem. I sleep well, not waking up too often, and I don't wake up with too much pain in the mornings.

Overall there has been a huge improvement on the pain front this week. Actually Dr. Millis predicted this would happen. When we spoke a week ago he said that I would probably notice a sudden lifting of pain over the next week or so; a disappearance of the constant aching pain that I'd had since the surgery. And so I did.

MOVEMENT

I have made great strides (sorry) in the movement department as well. With the reduction in pain, and the knowledge that I am not overly numbed with pain medication and am not likely to do anything that will "ruin" the surgery, I feel much less nervous about my right leg in general.

I can bend carefully in more directions and at sharper hip angles without the prior pinching; I can move my right (operated) leg out to the side or in across my other leg a little bit (not talking huge ballet swings here, maybe 20 degrees in each direction?); I can rotate my right foot inwards and outwards when my leg is stretched out before me. I can lift and move my leg more often now (which is still not that often) without using my arms to assist, but I can also tell that many of the muscles around my hip are (not surprisingly) very weak indeed and, once I get the go-ahead, are going to need some rehab work.

One thing I have not noticed with any of my increased movements is popping, grinding, clicking, snapping or any other Rice Krispies sounds or feelings coming from my hip. Perhaps that will come with larger movements, but so far so quiet.

I know that I have put a little more than the allowed weight on the operated leg at times (by accident) in the past week and I haven't had any pain result from those brief occasions. I am still under the hospital-discharge instructions to put no more weight on my operated leg than the weight of the leg itself (i.e. resting my foot on the floor), so that is what I do, but it feels like I am ready to put some more weight on the operated leg.

Honestly, with my pain so low and my movement so improved, sometimes this whole surgery/recovery/crutches thing feels fake. Like I could just throw my crutches aside and walk if I wanted to. I suppose that is a dangerous feeling because it could lead to me acting carelessly with a hip that, while feeling much better, is by no means even close to completely healed.

But it seems my naive pre-surgery superhero feelings have begun to resurface -- the ones that made me think this recovery wouldn't be that bad at all (at least not for *me*) and the ones that are making me think the doctor is going to tell me I can throw away the crutches and walk when I go see him on Tuesday. Thank God my parents never got me a Wonder Woman costume for Halloween as a child; I probably would have jumped off a building expecting to fly.

INCISION

One great reminder that none of this is fake at all is the five-inch scar across my abdomen. All the steri-strips are off and it looks amazing, see for yourself. Dr. Millis must have used skin glue or something because the incision has healed together so smoothly and so quickly. But I can't get too excited about it: he is going to reopen it to get the screws out eventually, and I don't know that it will heal up so nicely the second time around.

MOOD

I am in good spirits most of the time, especially now that the pain and itching have lessened and I've gotten more relaxed about the movement of my hip. I am not bored in the slightest: on the contrary I am relishing the opportunity to read voraciously in various media and keep up with my favorite TV shows and movies. This is the part of me that is hoping that the doctor does *not* tell me to throw away the crutches and walk next week. I'm not done with my pile of books yet!

Nevertheless, the bookworming has slowed down in the last couple of weeks as I'm back to working almost full days now during the week. I feel up to it mentally and so far I think I have been doing as good a job as I would be doing if I were physically in the office. Probably better, since I am comfortable and only have a 13-stair commute.

Two Weeks Post-Surgery: Movement

I am more mobile than last week in the sense that I am more confident on my crutches. Other than that there is not a significant amount of progress. I am in good shape for crutching -- prior to the surgery I did a lot of step-ups onto high platforms, squats, lat pulldowns, rows, triceps dips and other "crutch muscles" exercises, so I actually have not felt much difficulty crutching due to fatigue/weakness of any of the supporting muscles. (That said, I don't do much crutching other than around the house for necessary tasks only.) The real difficulty is with the muscles that were affected by the surgery in my right leg, as I describe below in the bit about the stairs.

I'm concerned sometimes that I accidentally put too much weight on the bad leg, or that I create too sharp an angle at the hip by leaning forward in a chair, for example. I left the hospital with instructions to keep the angle between my torso and thigh between 80 and 30 degrees (with 0 being flat out as when you stand up straight or lie down flat on the floor, and 90 being your knee brought up so your thigh is perpendicular to your body). So my concern is that I might accidentally push the hip a bit too far with weight-bearing or the angle, since I'm protected by the painkillers.

Or I might just fall on my face, like I did yesterday. I was waking up from a nap, and clearly not really fully awake or coordinated. As I got up from the couch and reached for my crutches, I lost my balance and fell forward. I caught myself mostly with other limbs, but I did land moderately hard on the floor with my right (op-side) knee, jarring my operated hip. It hurt right away (even through the painkillers) and of course I instantly panicked that I had done some sort of significant damage to my hip or hindered the recovery in some way. It feels OK today so maybe I am not made of porcelain. But lesson learned: wake up, THEN stand up.

I know I'm being a bit overly cautious, but I just really want to be very careful and treat my hip as properly as possible during this healing time, especially when it is so early and everything is so loosey-goosey in there; I feel like the slightest mistake (like clumsily falling) might cause some small setback or damage that would prevent the joint from healing as strongly and solidly as possible. I'm afraid that pushing oneself too hard and pushing the boundaries of healing too soon could create microscopic weaknesses in the healed joint that over time could cause pain, problems, and potentially more surgery. I want to heal this hip once, well, and for GOOD. (And then do the same thing to the other one.)

My current movement project is going down stairs -- as we know last week's breakthrough was sliding my right (op) foot forward using the hip flexor/upper quad when taking a step forward with my crutches. Going down steps is a slight variation on that, as I put the crutches on the lower step, place my right (op) foot on the lower step, then (with all my weight on the crutches) bring my left (non-op) foot down to the lower step where my crutches and other foot are. So the additional difficulty here is that rather than just sliding my right (op) foot forward, I also have to use muscles around my hip to support the entire weight of my right leg while the right foot is in mid-air over the lower step before I place it into position.

Previously I had either cheated by slithering my foot over the edge of the stair and down onto the lower stair (i.e. never losing contact with the ground) or having someone place my right foot on the lower stair with each step. But by now my hip flexor/upper quad muscles are strong enough for me to place my own foot on the stair below (sans slithering or assistance) for several steps in a row. This morning I made it down almost all of the 13 stairs down from the upstairs, so that was a pretty good achievement.

I still need help getting into and out of the shower (there is a high lip that I need help getting over with crutches, plus there are zero handholds to grab on to for support), but I can shower myself using my shower chair. Although a shower feels fantastic, the entire undressing/getting in/not falling off the shower chair/getting out/drying myself with all weight on left foot/redressing process is sometimes an exhausting ordeal, so the glee can be somewhat tempered.

I have been fine with using a normal toilet since I got home. I think this is due to my pre-surgery leg workouts -- my left leg has been doing quite well at lifting my entire body weight from various seated positions even when there is not really enough support for me to use my arms to assist.

Similarly I never got myself a leg-lifter to position my leg; I just grab it by the knee and move it around with my arms. To make small adjustments to the position of my lower leg I have been using an excellent trick I read in someone else's blog -- slip the non-operated side's foot under the ankle of the operated-side leg and use the good foot to adjust the position of the lower leg on the operated side.

I am perfectly comfortable sitting in an armchair with an ottoman for hours. I can sit in an armchair without an ottoman for a while as well, as long as I can slouch a bit. Dining room and kitchen table chairs are less comfortable, mostly because they involve eating (i.e. leaning over the table) and that causes greater-than-80-degree hip angle problems. I solve the angle problem by sitting on the edge of the chair and angling my thigh down towards the floor, with my foot under my chair. But as you can probably imagine, that is not all that comfortable for long periods of time either, so I prefer the armchair route.

The leg-under-the-chair solution is also helpful for getting up from armless chairs or other seating positions where there is not a lot of support nearby for using my arms to help me stand up. With my right leg under the chair and my right knee pointing 45 degrees towards the floor, I can lean forward to use my body weight to help me stand up using just my left leg, without creating an overly acute hip angle from leaning forward.

There has not been much progress in sleeping positions. As last week, I can sleep on my back (with two pillows under my right leg) or on my left side (with two pillows between my knees and one between my ankles) for long periods during the night. I can switch between these positions by myself, although it is not something I can do in a state of half-sleep, so I do still wake up several times per night to make these switches. Last night I must have been dreaming something topsy-turvy because I woke up in the midst of an attempt to turn on to my right (op) side to sleep. I did complete the turn, figuring I might as well try lying on the operated side, but that experiment lasted about one second, as it hurt immediately and not insignificantly.

Although I can't move all that much, my spirits are still high. I'm in a good mood most of the time, and I'm never bored. I have so much to read (books, magazines, newspapers, blogs) and so much to watch (Netflix! Hulu!) that the days pass quickly. I've also started to log back in to work this week, but so far I've just been responding to two weeks of emails and trying to get my inbox back in order.

Last Tennis Match

Five days to go.

Tonight I played my last tennis match before surgery. This time last year I was playing tennis two or three times a week, and was in the process of signing up for the three leagues I played in last summer, including one that I captained all the way to Sectional finals.

In the last couple of months I've played tennis maybe once every two weeks, with mixed results in terms of post-match pain. The decrease in my tolerance for a vigorous tennis match has definitely been one of the most saddening manifestations of my hip problems. I am hoping this surgery will bring me back to the courts as frequently and as capably as ever.

That said, of course I played some of my absolute best tennis tonight. Always good to go out on a high note.

My preparations for surgery are pretty much complete. I am on track to tie up all loose ends at work by Friday; I am on my way to being packed for what I expect to be six weeks away from my apartment in the city. I have not bought any of the equipment recommended by many other bloggers -- the grabbers or the sock donners or the bath chairs. I figure I will get (a parent to get me) what I need if I need it. I already have crutches from hurting my knee two summers ago. So my bag is mostly full of books and lounge pants.

My hip pain has been pretty minimal these last few weeks. It comes and goes, sometimes not seeming related to my activity level. During tennis yesterday I felt discomfort in the back of my right hip, or maybe in my lower back on the right side as a result of some compensation for the right hip. I also felt a sort of soreness on the outside of my hip, which is unusual. And afterwards of course the anterior labrum (basically the front of my hip, right at the crease when I lift my thigh) gave me some pain, which was to be expected.

My left hip has also piped up with a few twinges in the anterior labrum a few times this week. But none of this pain has been at all severe -- usually about 1 to 2 on a pain scale -- so it hasn't inhibited my activity more than to warn me that I should think about easing up.

Mentally I've been mostly unaffected by next week's events, other than a gradually receding paranoia that I will suddenly be felled with a cold and all my preparations and planning will be tossed out the window as my surgery is postponed for months and months. But as the days count down and I remain healthy, even that worry is fading.

Pre-Op Scheduling

Now that I have a surgery date, I have had to schedule all my pre-operative appointments. Before surgery I need a complete physical with blood panel, kidney function and liver function tests; autologous blood donations (giving my own blood for use during/after my surgery); and pre-operative appointments at the hospital.

The challenge is not only in coordinating schedules, but in planning dates that allow for proper hemoglobin replacement between blood draws and prior to surgery. My first blood donation cannot be earlier than six weeks before the surgery (February 2) and my last donation cannot be later than two weeks before the surgery (March 2). Moreover, one must allow seven to ten days between blood donations to allow the body to replace the missing pint of blood each time.

Two of my blood donations will be in New York at the New York Blood Center, which will ship my blood up to Boston. One of my donations must be on-site in Boston, as they need a very fresh on-site sample to separate into plasma and platelets for concentrated infusions during surgery. A shot of platelets in various areas can boost clotting during a bloody surgery (which any surgery involving bone-sawing necessarily is).

The schedule I have finalized is as follows:

February 3, 2009 -- Complete physical, including blood/liver/kidney levels, just to check everything and know my baselines. I'm getting this from a regular internist here in Manhattan and having the records sent up to Dr. Millis' office.

February 9, 2009 -- First autologous blood donation, at the New York Blood Center. After this appointment I am to ensure my diet has iron-rich foods and am to take iron supplements for five days.

February 19, 2009 -- Pre-operative appointments at Children's Hospital. During this full day in Boston I will meet with Dr. Millis, the anaesthesiology team, and admitting. I will also have my second autologous blood donation while I am there.

March 2, 2009 -- My third autologous donation, at the New York Blood Center, with the blood subsequently shipped up to Boston.

March 16, 2009 -- Surgery date.

Meanwhile, I have a more general goal of getting myself as strong and healthy as possible prior to the surgery. I have read that other women have experienced faster recoveries when they have gone into the surgery strong and fit. I also must try to eat a nutritious, iron-rich diet during this period of blood donations, as well as keep myself generally free of colds and other sickness. If one is sick one cannot donate blood; if one is sick in the days approaching surgery, the surgery will be postponed.

I've arranged my absence with work. I plan to be completely off the grid for two weeks after the surgery: one week in the hospital in Boston and one week sleeping and healing at my parents' house in Connecticut. During the third week (week of April 6), I plan to begin working remotely from Connecticut, although start day and hours per day are going to be contingent on how my recovery is progressing at that point.

I plan to stay in Connecticut for at least five weeks after returning from Boston, so I can have the help and supervision I would not have if I returned alone to my apartment in the city. Manhattan is NOT a friendly place for people on crutches, so ideally I would like to be almost off them before I leave Connecticut. Right now I anticipate physically returning to the office the week of April 27, but again that is contingent on my recovery speed.